The BMA has today issued ethics guidance to doctors working on the front line of the COVID-19 pandemic about the difficult decisions they are likely to face if the nation’s intensive care units reach capacity.
The doctors’ trade union and professional body has warned that as the pandemic spreads, doctors working in the NHS will face agonising choices about prioritising patients who need access to lifesaving interventions in the face of over-stretched resources.
It issued its guidance to doctors today1 to ensure that they have clear, authoritative and ethically sound support as they approach the challenges of these harsh decisions.
The BMA added that there needed to be an urgent public debate about these issues to ensure people understand the rationale behind the difficult decisions that will need to be made in this unprecedented time.
Dr John Chisholm, chair of the BMA’s medical ethics committee, said:
”The headlines are stark: a ‘tsunami’ of COVID-19 patients moving inexorably toward London’s hospitals and then heading to the rest of the UK. Despite heroic efforts to increase supply – and reduce demand – there may come a point where the pandemic will simply overwhelm intensive care beds, ventilators, ECMO life-support.
“As all working on this know, guidance, essential as it is, does not preclude the need to address these enormously challenging ethical questions. Guidance can indicate how to proceed. It cannot stop the choices being brutal or relieve decision-makers of their moral distress.
“Looking ahead to the coming weeks, if hard choices are required, we know they will be contested. There will be anger and pain. People who, in normal circumstances, would receive strenuous treatment may instead be given palliation in order to favour those with greater likelihood of benefiting. Nobody wants to make these decisions, but if resources are overwhelmed, these decisions must be made.”
Julian Sheather, specialist adviser, ethics and human rights, for the BMA, added:
”We need to start with justice or fairness. In times of plenty, fairness means allocating resources according to medical need. The greater the need the greater the resources – always provided the patient can benefit. Even before COVID-19, the NHS was not amply equipped. Resources were rationed by waiting lists and brevity of consultation. But – generally – the more ill you were the greater your priority.
”In our present circumstances, the question will no longer be how best to meet individual need, but how to maximise benefits from severely stretched resources. To the criterion of medical need must be added the patient’s likelihood of benefiting. It is preferable to save the lives of three patients with high need and a high likelihood of benefiting than one patient with high need and a low – but nonetheless real – chance of benefiting. This is the heart of the moral challenge."
Notes to editors
The BMA is a trade union representing and negotiating on behalf of all doctors in the UK. A leading voice advocating for outstanding health care and a healthy population. An association providing members with excellent individual services and support throughout their lives.
- For the full guidance, FAQs and audio briefing visit here
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